tbuckley/cabot-search huggingface dataset:
Abstract 10068: High Pericoronary Adipose Tissue Attenuation on Coronary Computed Tomography Angiography Predicts Cardiovascular Events in Patients Without Obstructive Coronary Artery Disease
Authors: Takahiro Nishihara, Toru Miyoshi, Keishi Ichikawa, Mitsutaka Nakashima, Takashi Miki, Masatoki Yoshida, Hironobu Toda, Masashi Yoshida, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito
Journal: Circulation (2022)

Introduction: Patients without obstructive coronary artery disease (CAD) have an increased risk of major adverse coronary events compared to patients with no coronary artery stenosis. However, risk stratification among patients without obstructive CAD has not been established. Hypothesis: This study was aimed to investigate whether pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography (CCTA), a novel imaging biomarker of pericoronary inflammation, is a useful predictor for cardiovascular events in patients without obstructive CAD. Methods: A total of 1183 patients without obstructive CAD undergoing clinically indicated CCTA in our institute from August 2011 and December 2016 were enrolled. Obstructive CAD was defined as luminal narrowing of ≧50% in any coronary artery. We also examined PCATA and high-risk plaque features on CCTA as well as coronary artery calcium score and pericardial fat volume. PCATA in Hounsfield units (HU) was assessed at proximal 40-mm segments of all 3 major coronary arteries. The outcome was composite cardiovascular events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. Results: During a median follow-up of 23.0 months, 32 cardiovascular events were observed. Left anterior descending artery (LAD)-PCATA in patients with cardiovascular events was significantly higher than that in patients without (-64.0 ± 6.0 HU vs -66.9 ± 7.3 HU, p=0.012), whereas right coronary artery- and left circumflex artery-PCATA were not. High LAD-PCATA was significantly associated with cardiovascular events in a model that included traditional risk factors, coronary artery calcium score and adverse CTA findings, such as degree of stenosis and high-risk plaque (HR; 1.467, 95%CI; 1.03-2.09, p = 0.033). Finally, incremental prognostic value of PCATA was evaluated. After adding LAD-PCATA to a model including traditional risk factors and the adverse CTA findings, global chi-square values increased significantly from 33.0 to 37.5 (p = 0.032). Conclusions: High LAD-PCATA has incremental prognostic value over conventional risk factors and CTA findings in patients without obstructive CAD.
Abstract 10072: Sex Disparities in Cardiovascular Events Among Sarcoidosis Patients: Insights From 2019 National Inpatient Sample
Authors: Nomesh Kumar, Renuka Verma, Kamleshun Ramphul, Yogeshwaree Ramphul, Hussien Kassem, Shaheen Sombans, Komal Kumari, Stephanie Mejias, Fnu Arti, Petras Lohana
Journal: Circulation (2022)

Introduction: Sarcoidosis involves many organs in the body, including the heart, thus triggering various cardiovascular dysrhythmias and complications. We sought to analyze the cardiovascular events seen in these patients. Methods: The 2019 National Inpatient Sample (NIS) is one of the most extensive inpatient databases in the United States. It was used to explore and identify patients diagnosed with sarcoidosis and a valid entry for the variable "Sex". Hospitalizations associated with several cardiac events were also examined (reported as cases per 100 males or females), and their occurrences were compared between males and females. Multiple logistic regression adjusted to non-cardiac characteristics allowed us to estimate the adjusted odds ratio (aOR) of the cardiovascular events in females relative to males. Results: We found 84,640 cases of sarcoidosis (61.5% females, and 38.5% males). Females were less likely to present with supraventricular tachycardia (2.1 vs. 2.4, aOR 0.804, p&lt;0.01), ventricular tachycardia (2.4 vs. 5.0, aOR 0.481, p&lt;0.01), paroxysmal atrial fibrillation (7.4 vs. 8.8, aOR 0.730, p&lt;0.01), ventricular fibrillation (0.3 vs. 0.5, aOR 0.705, p&lt;0.01), first degree atrioventricular block (0.6 vs. 1.1, aOR 0.543, p&lt;0.01), second degree atrioventricular block (0.4 vs. 0.6, aOR 0.622, p&lt;0.01), third degree atrioventricular block (0.8 vs. 1.6, aOR 0.510, p&lt;0.01), and heart failure (31.6 vs. 33.3, aOR 0.763, p&lt;0.01) than males. Conclusions: Males with sarcoidosis have a higher risk of cardiovascular events than females. Physicians should be encouraged to include routine cardiovascular checks in sarcoidosis patients.
Abstract 10720: Early Growth Trajectory is Associated With Post-Traumatic Stress in Parents of Infants With Congenital Heart Disease
Authors: Amy J Lisanti, Nadya Golfenshtein, Jungwon Min, Barbara Medoff-Cooper
Journal: Circulation (2022)

Background: Parents of infants with congenital heart disease (CHD) have described substantial stress over infant growth. Poor growth trajectory (GT) during early infancy may be a source of traumatic stress. The purpose of this study was to determine if differences exist in parent posttraumatic stress (PTS) between parents of infants with healthy versus poor GTs from hospital discharge to 4 months post discharge. Methods: This secondary analysis of a previously reported RCT (REACH telehealth trial NCT01941667) included parents of infants with CHD with stress measures at discharge and study end (n=136). Posttraumatic Diagnostic Scale was used to measure PTS. Weights were converted to weight for age Z scores (WAZ) using World Health Organization standards. WAZ-GT classes were identified using latent class growth modeling. We used multivariate logistic regression modeling to examine associations between WAZ-GT and parental PTS over the study period, adjusting for covariates. RESULTS One-quarter of parents (n=37, 28%) demonstrated at least moderate PTS symptom severity at discharge and one-third at study end (n=40, 31%). We identified four distinct classes of infant WAZ-GT (Figure). Among the identified GTs, two were considered healthy growth patterns: “stable around WAZ=0” (n=51, 37.5%) and “maintaining WAZ &gt; 0” (n=12, 8.8%). Therefore, these two patterns were collapsed to serve as one reference group for the analysis. Two additional WAZ-GT classes were identified that reflected poor growth: “partially-recovered” (n=44, 32.4%) and “never-recovered” (n=29, 21.3%). Parents of infants in the "never recovered" GT were at greater risk (OR=4.58; CI=1.54-13.64) for experiencing at least moderate PTS symptom severity at end of study as well as over time from discharge to end of study (OR=3.91; CI=1.60-9.86). CONCLUSION Results offer new insights that parents of infants with poor GT are at increased risk for persistent PTS and may need additional screening and intervention.
Abstract 10714: Disparities in Cardiovascular Investigator-Initiated Research Studies
Authors: Stacey Knight, Viet T Le, Benjamin D Horne, Kismet D Rasmusson, Jeffrey L Anderson, Kirk U Knowlton, Heidi T May, Joseph B Muhlestein
Journal: Circulation (2022)

Introduction: Recently there has been a much-needed focus on disparity and inequity in cardiovascular disease (CVD) care. Race, ethnicity, sex, and geography are shown to impact CVD care and outcomes. Perhaps one of the reasons for this is the lack of diversity and representation in CVD research studies, especially in non-sponsored research studies. Here we examine three investigator-initiated clinical CVD trials to describe current enrollment patterns and compare them to the comparable populations. Methods: Three Intermountain Healthcare, internally funded, CVD clinical trials were examined. These studies include a pragmatic trial, a randomized unblinded treatment trial, and a biobanking registry. Basic study characteristics and the comparison populations are shown in Table 1. Results: Demographic comparisons are shown in Table 2. Females were equally or slightly more represented in the studies. Minority races were under-represented in the pragmatic trial and the biobank registry. Rural or frontier counties were under-represented in the pragmatic trial and randomized trial. Hispanic/Latino patients were under-represented in all studies. Conclusions Females were well represented in all studies, but other minority groups were under-represented. The largest under-representation was for Hispanic/Latino patients. The reasons and mechanisms that may lead to under-representation and the impact on research results are unknown and deserve further study. While addressing these disparities may increase research costs (e.g., translation costs), future studies will benefit from the development of new resources and processes, and ultimately could lead to better care.
Abstract 10169: Do Beta-Blockers Confer Cardiovascular Protection in Patients With Stable Coronary Artery Disease in the Contemporary Era?
Authors: Lucas C Godoy, Michael E Farkouh, Peter Austin, Baiju Shah, Feng Qiu, Cynthia Jackevicius, Harindra C Wijeysundera, Harlan M Krumholz, Dennis T Ko
Journal: Circulation (2022)

Introduction: Previous studies have failed to show a cardioprotective benefit of beta-blockers in patients with stable coronary artery disease (CAD). These studies, however, were frequently limited by either small or heterogenous populations. We aimed to determine the association between beta-blocker therapy and long-term cardiovascular events in patients with angiographically-documented stable CAD. Methods: We identified all patients ≥ 66 years undergoing elective coronary angiography in Ontario, Canada from 2009 to 2019, who had significant coronary stenoses. Patients with heart failure or recent myocardial infarction (MI) were excluded. We used a new user design by defining beta-blocker use as ≥1 prescription claims in the 90 days preceding or after coronary angiography and excluded those with beta-blocker use in the previous year. The main outcome was a composite of all-cause mortality, hospitalization for heart failure or MI. Propensity score and inverse probability of treatment weighting were used to deal with confounding. Results: We included 28,039 patients (mean age: 73.0 ± 5.6y; 66.2% male), 12,695 (45.3%) were treated with beta-blockers. The 5-year rate of the primary outcome in the weighted cohort was 14.3% in the beta-blocker group and 16.1% in the no beta-blocker group (HR: 0.92; 95% CI: 0.86 to 0.98; p=0.006), which was primarily driven by reductions in MI (HR: 0.87; 95% CI: 0.77 to 0.99; p=0.031). No significant difference was observed regarding all-cause death (HR: 0.95; 95% CI: 0.88 to 1.02) and hospitalization for heart failure (HR: 0.93; 95% CI: 0.82 to 1.06). Findings were consistent across subgroups, including sex, age, diabetes, and previous revascularization (p-interaction &gt; 0.1; Figure). Conclusions: In patients with angiographically-documented stable CAD without heart failure or a recent MI, beta-blockers were associated with a significant reduction in the composite of all-cause mortality, hospitalization for heart failure or MI.
Abstract 10643: Anticoagulation Prescriptions for Patients With Acute Precipitants of Atrial Fibrillation in the VITAL-AF Study
Authors: Lakotah Hardie, Rachael Venn, Yuchiao Chang, Jeffrey M Ashburner, Shaan Khurshid, Marisa Shea, Steven McDermott, Leila H Borowsky, David D McManus, Steven Atlas, Patrick T Ellinor, Daniel E Singer, Steven A Lubitz
Journal: Circulation (2022)

Introduction: Many patients with incident atrial fibrillation (AF) are diagnosed in the setting of a potentially transient precipitant. Despite substantial rates of AF recurrence and stroke in this population, prior registries and survey data suggest lower usage of oral anticoagulants (OAC). Here, we examined use of OAC on the basis of precipitated versus non-precipitated AF among patients enrolled in the VITAL-AF trial. Methods: VITAL-AF (clinicaltrials.gov NCT03515057) was a cluster randomized trial of 16 primary care practices evaluating point-of-care AF screening using single-lead ECGs among individuals aged ≥ 65 years (n=30,715). The primary outcome of newly diagnosed AF at one year occurred in 503 patients. For each incident AF event, we performed manual chart review to classify if diagnosis occurred in the setting of an acute precipitant, if the episode was transient, and if OAC was initiated. AF was considered transient if there was documented return to sinus rhythm within three months of initial diagnosis. OAC initiation required both evidence of a new prescription and corresponding provider documentation Results: Of the 503 cases of incident AF diagnosed during the VITAL-AF study period, 125 (24.9%) occurred in the setting of an acute precipitant. The mean age of patients with newly diagnosed AF was 78.3 ± 9.0 years, 46% were female, 11% were non-white, and the mean CHA 2 DS 2 -VASc score was 4.2 ± 1.6, which were similar between those with and without a precipitant. Patients with acute precipitants of AF were more likely to have transient episodes (94% vs 76%, p=0.001) and less likely to be started on OAC (60% vs 82%, p&lt;0.001) than patients without a precipitant. In a multivariable model adjusted for age, race, gender, CHA 2 DS 2 -VASc score, study arm, and screening status, AF occurring in the context of a precipitant was associated with significantly decreased odds of OAC initiation (odds ratio [OR] 0.32, 95% CI [0.20, 0.52]). Conclusions: Patients diagnosed with precipitated AF are more likely to have transient episodes with return to sinus rhythm within three months of diagnosis and less likely to be started on OAC compared to patients without a precipitant. Future analyses examining the effectiveness of OAC among patients with precipitated AF are warranted.
Abstract 10017: Which Thrombi at the Apex of the Left Ventricle Were More Prone for Embolization and Stroke?
Authors: Thach N Nguyen, Wei Hsu Che, THIEN PHAM, Cardy Nguyen, Nga Nguyen, Ha Le, Mai Q Hoang, Trang Le, Quang Dat Ha, LOC Vu, Quang Phuc Vu, Duong Huynh, Sarthak Aggarwal, Thoa Le, Imran Mihas
Journal: Circulation (2022)

Introduction: Patients with apical thrombus due to anterior wall ST segment Elevation Myocardial Infarction (AWMI) or dilated cardiomyopathy (DilCM) have high risk of emboli, including stroke. Hypothesis: Which factor of a thrombus at the apex of the left ventricle makes it vulnerable for or resistant to embolization? Is it its loose (or well organized) tissue formation as a fresh (or old) thrombus so it disintegrates quickly (or stays resistant) and becomes vulnerable for (or less prone to) embolization? Methods: Patients with AWMI or DilCM with apical thrombus by echo were consecutively enrolled. Patients with atrial fibrillation were excluded. The data to be collected included: (1) Time of discovery of apical thrombi by echo to time of stroke (2) result of treatment (thrombolysis with long term vit K antagonists vs novel oral anticoagulants (NOACs) and (3) pattern of recovery. Results: From 2010-2021, there were 32 patients identified with apical thrombus. 12 patients due to AWMI and 20 patients due to Dil CM. 3 AWMI patients developed stroke (25%) within a mean of 7.5 days after discovery while only 2 patients with Dil CM had stroke (10%) 21 days after discovery (p&lt;0.05). At the time of stroke, all apical thrombi of AWMI patients were small, of round shape, protruding out and of heterogenous consistency (mixed black and white intensity on echo). The patients responded well to thrombolysis and recovered near completely. While for patients with Dil CM, all apical thrombi were moderately large, of flat surface incorporating into the contour of the apex, non-protruding and of homogenous consistency. When these patients had stroke, the size of stroke was large and more resistant to thrombolysis. Their recovery was slow with a lot of deficits. Conclusions: For apical thrombi from AWMI, the thrombi were fresh so they disintegrated quickly and could cause more stroke however because of their smaller size and loose consistency, the recovery was more complete. The apical thrombi from Dil CM were more organized so they dissolved more slowly, caused less stroke however they were more resistant to thrombolysis. Their recovery was more limited. Larger database needs to confirm the above findings and their clinical implications.
Abstract 101: Distinctive Individual Effects of LPC(18:2) and LPC(22:6) on Survival and Neurological Outcomes After Cardiac Arrest: Combination As A Future Therapy
Authors: Rishabh C Choudhary, Tai Yin, Blanca B Espin, Muhammad Shoaib, Mitsuaki Nishikimi, Tsukasa Yagi, Lance B Becker, Junhwan Kim
Journal: Circulation (2022)

Introduction: Decreased plasma Lysophosphatidylcholine (LPC) was found to be associated with survival after cardiac arrest (CA) in humans and rats. Supplementing LPC species containing docosahexaenoic acid, LPC(22:6), improved rat brain function and survival after CA. Thus, LPC deficiency may be a major cause of CA pathology and LPC supplementation may be a novel therapeutic approach to CA. However, the therapeutic effects of individual LPC species are not fully understood, particularly a species containing linoleic acid, LPC(18:2). While 22:6 is an omega-3 fatty acid and highly abundant in the brain, 18:2 is omega-6 and minimally present in the brain. Therefore, we hypothesized that the protective role of LPC(18:2) may be different from LPC(22:6). Furthermore, LPC(18:2) may provide additive protection when administered together with LPC(22:6). Objective: To investigate the protective role of supplementing LPC(18:2) compared to LPC(22:6) after CA. Methods and Results: We first compared the relationship between plasma LPC(18:2) levels and outcomes of CA patients as compared to LPC(22:6). LPC(22:6) was found to be associated with both survival and neurological outcomes, whereas the levels of LPC(18:2) were associated with survival only. We then tested whether supplementing LPC(18:2) can improve survival and neurological function in rats undergoing 10 minutes of asphyxial CA. Supplementing LPC(18:2) post-resuscitation significantly improved survival as did LPC(22:6) in rats. Although LPC(18:2) supplementation improved in some individual neurofunctional tasks, the overall neurological function of survived rats was not improved. Particularly, while 3 of 7 survived rats treated with LPC(22:6) were able to walk across a ledge, none of 10 survived rats treated with LPC(18:2) were able to cross the ledge. Conclusion: Significantly improved survival without significantly improved brain function in rats and poor correlation with neurological outcomes from humans suggest that LPC(18:2) may protect organs other than the brain. The results further indicate that different LPC species have different mechanisms of improving outcomes, demonstrating the potential of utilizing different combinations of LPC as improved therapeutic treatments in CA.
Abstract 10194: Acute Pericarditis in Patients With Breast Cancer - A Statewide Study
Authors: Daniel M Shindler, Davit Sargsyan, Georgia Barbayannis, Javier Cabrera, John B Kostis, William J Kostis
Journal: Circulation (2022)

Introduction: Acute pericarditis has not been linked to long-term heart-specific morbidity in breast cancer patients. Carcinomatous pericardial involvement has been detected at autopsy in 10-20% of breast cancer patients. In clinical practice, when it comes to primarily echocardiographically-diagnosed pericardial diseases: pericardial effusion, cardiac tamponade, and pericardial constriction have all been reported in breast cancer patients. Acute pericarditis is primarily a clinical non-imaging bedside diagnosis derived from the combination of chest pain, pericardial rub, and typical electrocardiographic changes, irrespective of the presence or absence of pericardial fluid on imaging. It can be the initial clinical manifestation of a malignancy. Methods: The Myocardial Infarction Data Acquisition System (MIDAS) database is an ongoing, longitudinal, and validated database that comprises discharge data, along with demographics, comorbidities, and length of hospital stay; for all patients with cardiovascular diseases admitted to every non-federal acute care hospital in the state of New Jersey. We searched for the diagnosis of acute pericarditis (ICD-9 codes 420.0, 420.90, 420.91, and 420.99), in first hospital admissions of female patients with breast cancer (ICD-9 codes 174.0-174.9) between January 1995 to December 2015. Controls were female breast cancer patients without the diagnosis of acute pericarditis. Results: There were 60,435 female patients with breast cancer. Of those, 253 (0.4%) were also diagnosed with acute pericarditis on the same admission as the first breast cancer diagnosis, or later. Analysis for comorbidities showed that 116 (45.8%) of the 253 patients with acute pericarditis had admissions for heart failure, as opposed to 26.4% (15,895 out of 60,182) of breast cancer patients without acute pericarditis (p &lt; 0.00001). Conclusions: Since New Jersey has a diverse population that resembles the profile of the United States in age, gender, and race/ethnicity; our findings could also be generalized to other geographic areas, and may help with future clinical guidelines. Although it is rare, acute pericarditis in breast cancer patients can indicate long-term cardiovascular morbidity.
Abstract 10747: Left Atrial Volume Index is Associated With New-Onset Heart Failure Admission and Cardiovascular Death in Patients With Asymptomatic Moderate Aortic Stenosis
Authors: Mika Maeda, Taku Omori, Ken Kuwajima, Takahiro Shiota
Journal: Circulation (2022)

Background: Left atrium enlargement is the marker of increased left ventricular (LV) filling pressure and morphological indicator of chronically increased hemodynamic burden. However, the potential utility and clinical significance of left atrial volume (LAV) index in asymptomatic moderate aortic stenosis (AS) patients have been unknown. Therefore, we assessed the impact of LAV index on cardiovascular events in asymptomatic moderate AS patients. Methods: We retrospectively analyzed 549 patients (mean age 79±13 years) with asymptomatic moderate AS (mean transaortic pressure gradient 20 to 39 mmHg) and LVEF ≥50 %. Cardiovascular events were defined as cardiovascular death or admission for heart failure (HF). Results: During a follow-up period (median, 1301 days; range, 296 to 2179 days), 216 patients underwent aortic valve replacement (AVR) or balloon aortic valvuloplasty (BAV), and 132 HF admission and 37 cardiovascular deaths occurred. In the multivariable analysis, LAV index, lateral E/e′, and peak tricuspid regurgitation velocity were independent predictors of cardiovascular events (Hazard ratio (HR) 1.07 [1.05 to 1.09]; HR 1.04 [1.00 to 1,08]; HR 1.04 [1.00 to 1.07], respectively) after adjusting for age, female, body mass index, previous myocardial infarction, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, moderate mitral regurgitation, E velocity, LV hypertrophy, and surgical or transcatheter AVR or BAV. LAV index of 27 mL/m 2 was the optimal cutoff value for predicting cardiovascular events with sensitivity of 89% and specificity of 60% and C-statistics for LAV index demonstrated superiority to lateral E/e′ and peak tricuspid regurgitation velocity ( P &lt;0.001) (Figure). Conclusion: LAV index is an important predictor for cardiovascular events in asymptomatic moderate AS patients.